No, my surgeon was not able to change their mind. Here is the direct wording of the denial (first the rules and then the denial reason);
"Surgical treatment of morbid obesity received from a Network or ONA-PPO Provider is covered. All of the following criteria must be met:
*Covered Person mus have a minium BMI of 40;
*Covered Person must have documentation of a diagnosis of morbid obesity for a minimum of five (5) years from a Physician;
*Covered Person must be 18 years or older; and
*Surgery must be performed at a network or ONA-PPO Provider by a Network or ONA-PPO surgeon. This is true even if there are no Network or ONA-PPO Providers near the Covered Person.
Benefits are limited to one procedure during the entire period of time you are covered under AT&T Medical.
As per the clinical documentation, this patient had a weight of 185 pounds with a BMI of 29 in 2004, and therefore, does not meet the Benefit Document criteria for coverage of the requested bariatric surgery which requires the documentation of a diagnosis of morbid obesity (a minum BMI of 40) for a minimum of five (5) years from a Physician. Therefore, the requested service is not a covered benefit at this time."
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